Laparoscopic and Robotic Prostatectomy

Laparoscopic radical prostatectomy
and robotic prostatectomy are two surgeries
for prostate
cancer treatment. The two
are similar, but robotic surgery is performed with a
machine that is controlled by a surgeon and laparoscopic
surgery is performed by the surgeon. Patients who want
to opt for one of these procedures should look for surgeons
who are experienced in a specific technique. Whether
a surgeon performs well either manually or robotically
depends mainly on experience.

The laparoscopic and robotic prostatectomies
are performed using one of two approaches: extraperitoneal
and transperitoneal. The peritoneum is a thin membrane
that covers the abdominal cavity. The extraperitoneal
prostatectomy does not cut through this membrane, while
the transperitoneal prostatectomy does. Some doctors
cite shorter recovery times and fewer complications
for patients who have undergone the extraperitoneal
prostatectomy.

The laparoscope is a slender instrument
that is shaped like a tube. A surgeon is capable of
seeing through the laparoscope and performing the prostatectomy
through a series of small incisions, as opposed to one
long abdominal incision. The surgeon uses the laparoscope
to gradually detach and remove the prostatic tissue.
Researchers are still a few years from knowing whether
the laparoscopic prostatectomy is capable of removing
all of the prostatic tissue and having the same outcomes
as the radial perineal and retropubic prostatectomies.
A few of the advantages of laparoscopic prostatectomy
include quicker recovery time and less abdominal pain.

During the Prostate Surgery
During the prostatectomy, the patient lies supine in
some degree of the Trendelenburg position. Supine means
on the back and facing up. The Trendelenburg position
means the pelvis is raised above the head and the head
is lowered between 15 and 45 degrees. The surgeon makes
5, or sometimes 6, small incisions in the lower abdomen.
The number and pattern of the incisions depend on whether
the prostatectomy is transperitoneal or extraperitoneal.
Because there is no large incision that gives the surgeon
an open view of the prostatectomy, removal of the lymph
nodes to determine metastasis as well as the nerve-sparing
technique become extremely difficult. Patients for whom
maintaining sexual potency is a priority and who want
the laparoscopic or robotic procedure should find surgeons
who are experienced with the nerve-sparing technique
in this type of prostatectomy.

In the robotic prostatectomy, a
surgeon sits at a console and performs the surgery remotely.
The robot that “performs” the surgery consists
of the surgeon console, the display system, the master
arms, the control panel, the central processing unit,
and the robotic arms. The surgeon controls the master
arms which control the robotic arms that hold the surgical
tools. The surgeon receives feedback from the machine
which indicates the pressure exerted by each tool on
the patient. The surgeon uses the display system to
view the stereoscopic image of the prostatectomy. The
image may be in 2 dimensions or 3 dimensions with variable
angles and magnifications.

Advantages of the Robot
There are some advantages, mostly for the surgeon, during
robotic prostatectomy. The movements of the master control
are intuitive, meaning that when the surgeon moves the
control to the right, the tip of the instrument is moved
to the right. The laparoscopic prostatectomy is counterintuitive,
which means direction is reversed. The robotic arms
do not tremor as human hands do and the display screen
is capable of zooming and scaling in a way that the
human eye cannot. The robotic instruments have a greater
range of motion than a human wrist. Though these benefits
appear to make the robotic surgery more desirable, patients
should remember that an experienced surgeon performing
a laparoscopic prostatectomy is usually a better choice
than an inexperienced surgeon performing a robotic prostatectomy.
The best medical results are correlated with experience.